Citation Nr: 21024351 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-14 149 DATE: April 22, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include depression, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to October 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision. The Veteran testified at a hearing before the undersigned Veterans Law Judge in November 2018. A transcript is of record. In March 2019, the Board remanded the case for further development. The case has since been returned to the Board for appellate review. 1. Entitlement to service connection for an acquired psychiatric disorder In a January 2020 VA medical opinion, the examiner opined that the Veteran’s unspecified depressive disorder was less likely as not the result of military service, events in-service, or a service-connected condition. The examiner also stated that there was no indication that the Veteran’s depression was aggravated beyond its natural progression by his service-connected knee disabilities. However, the examiner did not address the lay statements of record, as directed by the Board in the March 2019 remand. Moreover, the examiner provided no supporting rationale for her opinion regarding aggravation. In a December 2020 VA medical opinion, the examiner stated that he could not offer an opinion regarding the relationship between the Veteran’s service-connected disabilities and his depressive disorder without resorting to mere speculation. However, the examiner recommended that the Veteran undergo an additional VA examination in order to obtain a medical opinion. The Veteran was afforded an additional VA examination in January 2021. The examiner opined that it is less likely as not that the Veteran’s current depression had its onset in or is related to service. In so finding, the examiner stated that the Veteran first reported having depression within two months of filing a claim for depression. However, the examiner also stated that the Veteran’s records indicated that his depression had its onset in 2000. Notably, the Veteran filed a claim for service connection for depression in February 2013. As such, it appears that the opinion was based, in part, on an inaccurate or incomplete factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (finding that a medical opinion based on incomplete or inaccurate factual premises is not probative). The January 2021 examiner also opined that the Veteran’s depression was not aggravated by his service-connected knee disabilities. In so finding, the examiner stated that people with pain commonly experience impaired sleep, irritability, discouragement, or depression over their altered function. The examiner stated that this is a normal and usual course for “depression in light of pain and chronic social stressors.” However, the examiner did not address whether the “normal and usual course” of the Veteran’s depression in the context of pain from his service-connected disabilities was an incremental increase in his depression without such pain. In addition, although the examiner provided a review of the Veteran’s VA medical records, it is unclear whether she fully considered the evidence regarding the Veteran’s mental health symptoms and pain. For example, the examiner summarized findings from a February 2013 VA psychiatry record, but she did not address the Veteran’s lay statements regarding his knee pain and side effects from Prednisone. The examiner also referenced an April 2013 VA pain assessment in which the Veteran reported that his pain did not affect his normal daily activities; however, she did not address that the assessment pertained to pain located in the Veteran’s left upper quadrant. In light of the above, and although the Board sincerely regrets the delay, a remand is necessary to obtain an additional opinion regarding the etiology of any acquired psychiatric disorder. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). Lastly, during the November 2018 Board hearing, the Veteran testified that he received an Article 15 shortly before his separation from active duty after testing positive for drugs. An October 1989 service personnel record noted that the Veteran’s rank was reduced and listed the Uniform Code of Military Justice (UCMJ) as “additional instructions.” However, the service personnel records that are currently associated with the claims file do not include records pertaining to an Article 15 proceeding. Therefore, on remand, the AOJ should obtain any outstanding service personnel records from the Veteran’s period of active duty. 38 C.F.R. § 3.159(c). The matters are REMANDED for the following action: 1. Obtain any outstanding service personnel records, including any records pertaining to an Article 15 proceeding during the Veteran’s period of active duty from October 1985 to October 1989. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. 2. Obtain a VA medical opinion from an appropriate clinician regarding the etiology of any current acquired psychiatric disorders. The entire claims file must be made available to the examiner. (a) The examiner should identify all current acquired psychiatric disorders, including any depression. (b) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s disorder had its onset in service or is otherwise causally or etiologically related to service. (c) The examiner should also provide an opinion as to whether the disorder was caused or aggravated by the Veteran’s service-connected right and left knee disabilities. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. In providing this opinion, the examiner must comment on the Veteran’s statements of experiencing psychiatric symptoms and self-medicating during service. See, e.g., November 2018 Board Hearing Transcript. The examiner must also address the lay statements provided by the Veteran’s spouse, sister, and friend. See January 2019 correspondence. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If there is a medical reason to doubt the history as reported, the examiner should so state. All opinions must be supported by detailed rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Wulff, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.